Nurse and Patient Interaction through Therapeutic Communication

Rusmarita Hema Malini Ira Kusumawaty

Student of Postgraduate, Associate Professor, Lecturer at Poltekkes
Faculty of Nursing, University of Faculty of Nursing, University of Palembang
Andalas Lecturer at STIK Andalas
Bina Husada Palembang

ABSTRACT : Therapeutic communication is a Keywords : Experience nurse and therapeutic

communication performed by nurses to patients communication
with a goal to help the healing process, but the
1. INTRODUCTION .
phenomenology of the field are still many nurses
who have not applied therapeutic communication
Therapeutic communication is very
properly. This study was to determine the depth
important to use, professional communication
of the application of therapeutic communication
aimed at healing the patient. The nurse's ability
phase inpatient hospital in Palembang South
to communicate affects the patient's assessment
Sumatera. This research uses the descriptive
of the nurse as well as the nurse's sense of her.
method of qualita tif with phenomenology
Each intervention made by the nurse is
approach using in-depth interview technique. The
performed using therapeutic communication.
informant selection technique used purposive
Therapeutic communication techniques are
sampling , the informant consisted of 8 nurses.
nurses skills that must be trained and trained
Method of analysis of this research is Moustakas
every time, nurses need to analyze who will be
method. Related experiences nurse apply
communicating, interacting with pediatric
therapeutic communication there are 7 themes
patients, adolescents, will not be the same
obtained in the inpatient room at South Sumatera
techniques of communicating with elderly
Hospital. The ineffectiveness of therapeutic
patients, psychiatric patients as well as with
communication between the nurse and the patient
patients who are in terminal condition. The
in interacting is useful to improve the patient's
existence of therapeutic communication skills ,
recovery. The presence of training for nurses on
nurses will more easily establish a relationship of
therapeutic communication and the existence of
mutual trust with clients, so it will be more
operational standards of therapeutic
effective in achieving the goals of nursing care
communication procedures .
that has been applied, provide professional
satisfaction in nursing services and will improve
the profession (Damayanti, 2008).
Research conducted by Roberts &
Bucksey, (2007) found there are some non verbal
and verbal aspects shown by health workers in
communicating with patients and done more to
speak as a patient and Air behavioral content
(advisory), which consists of verbal and
nonverbal communication commonly touched
(54%) and gaze by the patient (84%) .
Research conducted by Yularsih, (2014) on
application of therapeutic communication, to
obtain the result that communication in the ward
has a significant effect on patient satisfaction and
accelerate the patient's recovery. The application
of therapeutic communication is not only done in
the wards of care, but it has been started since the
patient is still in the poly clinic, is expected with
the application of therapeutic communications
patients will feel comfortable while undergoing
hospitalization and treatment satisfied with the
services provided by the hospital in Semarang.
The results of interviews with two nurses at
the inpatient who were inquired about therapeutic
communication were obtained by two nurses
saying that the implementation was good enough
although there were still some stages of
therapeutic communication that had not been
done yet . This study aims to explore experience
nurse in the application of therapeutic
communication on patient.
II. RESEARCH METHOD
In this study, the researcher attempted to
reveal the nurse's experience in carrying out
therapeutic communications to the patient, so
that the appropriate qualitative research design is
used using phenomenology. As for making the
participants was done by using purposive
sampling, with the criteria of nurses who become
participants in this study were nurses who beaker
ja in the inpatient unit, minimum education DIII
of nursing, is willing to be a participant in the
study as evidenced by a signed statement
indicating agreement with the research, were able
to apply communication therapeutic, and in place
at the time this study was conducted. This
research was conducted in Hospital South
Sumatera . The study was conducted from June
2017 to May 2018. Data collection methods in
qualitative research were conducted on natural
conditions, primary data sources, and more data
collection techniques on in-depth interviews,
observation and documentation studies. The
process of data analysis in qualitative research
with phenomenology approach, analyzed based
on moustakas method where a data analysis that
can follow the systematic procedure that moves known that all i nforman aged over 21 years in
from the narrow analysis unit ( keyword) to the which show informers in this study is mature
wider system ( tema ) then to the description because of his age is mature. Based on the
details that summarize two elements, namely; informant's educational description, it is known
what individuals have experienced and how they that some of the informants are educated in
experience them (Creswell, 2015) .   Nursing DIII so it can be said that they have been
able to think critically and scientifically. Based
III. RESULTS AND DISCUSSION
on the picture of the work of health workers that

Participants in this study were nurses who they at least have enough experience because it

worked in the inpatient ward as many as 8 lebih of 1 month and everything meets k riteria

people. Characteristics of participants described informants who have been determined. Informant

in the demographic data consist of initials, age, research plan amounted to 10, but there are only

sex, occupation, education, employment status, 8 informants because 1 informant has been done

and length of service in the ward in South for the instrument test and the 1 informant again

Sumatera Hospital. Demographic info can be maternity leave, so that there are only 8

seen in the table below.               informants. The head of the room is used as
source triangulation. Rose room used as a place
              The results of in-depth interviews about of study because the room is a third class room
the characteristics of man data in obtaining the and all types of diseases are placed there, and
picture of age, education and years of service. each pershift his nurse only 2 people who serve.
Based on the age description of informants it is
 

Table
Keywords, categories, sub themes and themes the nurse's experience in applying therapeutic communication
No Keywords Category Subthemes Tema

1. -           Communication The nurse's a. The nurse has  

nurse with patient relationship with knowledge of
  -           To improve the the patient therapeutic
patient's recovery communication
-    Planned  
  -           Know the Helping clients b. Strengthening  
complaints the relationship n
-           Comfortable Fostering therapeutic
Accept conditions relationships with
  patients
  -      Pre interaction Therapeutic c. The nurse's job
-      Introduction communication in fostering the
  -      Orientation process interaction with the
-      Work patient
-      Termination  
 
  d. Review
-        Facilitate the nurse the patient's
in taking action Identify actions problem
 
2. - Dig yourself up Assessing your Identify weaknesses   Identify to
-     - Prepare yourself own feelings and shortcomings overbalance   and
lack of self
 
3. -   Name the nurse Ask the patient's Open attitude to clients Fostering
-    Ask for the patient's identity relationships   mutual
  name trust
-    Say greeting
 
4. -      - Asking for Implementation of Evaluate the results of Me the value of
complaints both meetings past actions interaction in
  -        Evaluate the communicating
contract     therapeutic with the
  -        Plan the action
-        patient
 

5. Take action Solution to Help clients dig Working together to

  problem important things solve patient
  problems
 

6. -   Asking for feelings Agree on follow- Re-conclude from the Evaluate the
-   Regards up action result achievement of the
    objectives of the
  interaction

7. Difficult to Resistens in Client non-conformity to Facing the patient's

communicate communication change difficulty in
  communicating
 The themes in this study resulted from in- relationship with patients, there are four sub
depth interviews and supported by observation themes that make up the theme:
and documentation studies during the data a. The nurse has knowledge of therapeutic
retrieval process. info analysis yields 7 tema as communication
the result of research are: Fostering therapeutic             The results showed that nurse
relationship with patient, identifying nurse participants who performed therapeutic
readiness before communicating with patient, communication had knowledge about
building trust relationship, patient, assessing therapeutic communication. Some
interaction in communicating therapeutic with participants said about the definition of
patient, doing cooperation to overcome patient therapeutic communication that is seen from
problem, evaluating achievement purpose of several participant conversations as follows:
interaction, difficulty facing patient in " Communication is done by all health
communicate. personnel to deck patients, especially nurses
IV. DISCUSSIONS deck. Interpersonal communication to the
1. Fostering Therapeutic Relationships patient nurse n yes because there is a
with Patients purpose to help cure the patient "(1.1).
      Therapeutic communication can be Meanwhile, the other participants declared
undertaken by nurses by fostering therapeutic .... " Communication between nurses and
relationships with patients well. Some sub deck patients who have a goal to speed
themes are : Nurse has knowledge about healing of patients " (1.3)
therapeutic communication, strengthen Therapeutic communication is nurse
relationship with patient, nurse duty in fostering communication with the patient to improve
interaction relationship with patient, to study the cure of the planned patient , the nurse
patient problem. the nurse says that there is an knows about the therapeutic communication
understanding of the meaning or definition, the and nurse's communication also expresses
purpose, stages and benefits of therapeutic the statement clearly and completely
communication that can be explained by the although there are still only partially answer
nurse itself. it incompletely.
Therapeutic communication is maintained by Therapeutic communication is
the nurse by fostering a therapeutic consciously planned and the aims and
activities focused on the patient's recovery,
and is a professional communication that
leads to the goal of healing a patient
performed by a nurse or other health worker
referred to as therapeutic communication.
Therapeutic communication can not take
place by itself, but must be planned,
considered, and implemented professionally.
A communication process terape u tick nurse
should know the basics, objectives, benefits,
process or technique and communication
phases and execute it with the right attitude
at the hospital (Mundakir, 2006).
Meanwhile, the elite results of Siti &
Indrayana, (2015) that therapeutic
communication is communication very
important by nurses profesiona l that it aims
to speed up the case embuhan patient .
Patient satisfaction can occur if the need,
desire, ter patient's expectations can be
fulfilled.
This study reveals that nurses have
knowledge about therapeutic communication
and are very helpful in the process of healing
the patient and first planned in accordance
with the action to be performed.
b. M empererat relationships with patients
    The results of this study indicate that
the therapeutic communication activities of
participants with patients to be better, can be
seen from some participants who said about
digging information about patient problems:
" In order for the patient comfortable in our
care deck, we certainly need information
about the patient's complaints right with
therapeutic communication we can dig up
information on patients ranging from
complaints and bagaim a na to enter the
hospital "(1.1)
Therapeutic communication activities
undertaken by the nurse aim to know the
patient's condition, the sense of comfort for
the nurse and the patient and the patient can
accept the situation. The relationship of
giving each other and received between the
nurse and the patient in the nursing service is
referred to as therapeutic communication of
the nurse is a professional communication
nurse (Purwaningsih, W & Karlina, 2010) .
Important things in communication
therapeutic through the relationship of
nurses and patients who are built with Well,
nurses and patients work together to achieve
goals (Nugroho, 2009 ) . Simamora
research , (2013) that there is a therapeutic
communication intensity of nurses and
pediatric patients that are categorized to the
frequent level that is an average of three
times a day. In addition to the therapeutic
intensity of the nurse's communication in
relation to the patient's passion for healed is
very positive or good.
 In this study that the relationship of
nurses with patients in communicating it will
strengthen the relationship between nurses
with patients , where for a professional
relationship in nursing services.
c. The nurse's job in fostering the
interaction with the patient
    The results of this study indicate that
the nurse's duty to build relationships with
patients. Some participants said about the
several stages of therapeutic communication
performed by the participants: "there is a
pre-stage of interaction, Phase introduce,
orientation, stage work and termination
stage" (1.1) and "Stage pre interaction,
orientation, the working stage, termination
stage "(1.2)
The nurse understands about the task
in the therapeutic process or stage where
there are 4 stages that are done, namely pre-
interaction stage, introduction / orientation,
work phase and termination stage. Research
done by Nugroho (2009) showed that the
therapeutic communication applied consists
of four phases / stages, namely prereteraksi
phase, action phase , evaluation phase , and
phase documentation , in doing therapeutic
communication with patients, the peraw at,
using the techniques and certain attitudes.
The relationship between nurses and patients
is important in therapeutic communication.
Through a well-nurtured relationship of
nurses and patients, nurses and patients work
together to achieve goals.
d. Review the patient's problem
     H acyl research shows most
participants claimed to communicate to
conduct an assessment on the patient's health
problems. B ome participants say d apat
simplify the process of actions performed
with the following statement: "Memper easy
to process in m e take action if the patient's
nursing deck He believed kept happy with
our simple enough deck of action" (1.2) and
" Patient happy to keep doing the action is
also good if the family or patient agrees to
keep open so it is easier for us too. Continue
if we want to ask about the complaints the
patient can also get the information we
really need the deck " (1.1)
           The nurse can perform the action by
examining the patient's problem easily when
using therapeutic with patient and in the
process of communicating the therapeutic
utik will get information that will be needed
and tapa some of the benefits needed when
communicating therapeutic.
The benefits of therapeutic
communication are to encourage and
advocating cooperation between fellow
nurses with patients through
nurse relationship with patient . Meanwhile,
 research conducted by Rahma (2016) found
that t erapeutic communication between the
nurse and the patient has been going well ,
this is reflected in the way the nurse provides
a gentle direct communication and facial
expression which is pleasing to the patient
also with the gift of attention to the patient
by gently refreshing the patient's complaints,
giving feedback is easy to understand and
always smiling friendly and speaks politely .
2. Identify strengths and weaknesses
Therapeutic communication is undertaken by the
nurse by identifying the nurse's readiness before
interacting with the patient with  understand self
and prepare beforehand interacting with patients,
where there are sub tem a that form the theme
are: identify weaknesses and shortcomings
The results of this study indicate that
participants before running therapeutic
communication to the patient first do self
preparation by examining what the weaknesses
and shortcomings in the nurse itself. This is the
pre-interaction stage of the therapeutic
communication process, the participant's
statement as follows: " We must first prepare our
deck first (1.1) and " Before we make our
communication as nurses need preparation as
well as deck. Our ability must also be clayed and
in our ability to dig again " ( 1.2)
      The nurse must have good skill and skill,
and more importantly that is self-digging, the
preparation and know the weakness and strength
of the nurse's own where the nurse is in
prainteraksi phase. The structure in therapeutic
communication , according to Stuart (1998) dar i
comprises the first phase that is: Preinteraction
phase this is the preparatory period before
starting to get in touch client. The duties of
nurses in this phase are: explore per despair,
hope and anxiety, analyze their strengths and
weaknesses, with a self-analysis to maximize
iaakan trained himself to be worth therapeutic for
the client, if feeling unprepared then need to
learn bali, discussion group friend, collect data
about the client, as the base and nature of making
interaction plan, make a meeting plan in writing,
which will implemented when meeting with
clients.
     In Rahman's research, (2013) that the pre-
interaction phase, the nurse in motivating healing
addicts of narcotics and addictive substances is
the phase before the nurse directly plunges
interaction with the client. Nurses should prepare
everything, client data, information about clients
and prepare emotions and mentally before
meeting clients .
       This study shows that when nurses do
prainteraksi phase then the nurse should be able
to explore the ability of self by assessing the
strengths and weaknesses of nurses and me
prepared a self-therapeutic, which assess the
strength by means of capabilities and advantages
that exist didiri nurse. Seme ntara it to the
disadvantage of nurses assess itself by what
became his tid ak deficiency can be made to
communicate with the patient.
3. Fostering Trusted Relationships
Therapeutic communication is
undertaken by nurses by fostering trusting
relationships with patients when interacting
with patients, where there are subtitles that
form the theme: open attitude to clients . The
results of this study indicate that the
participants conducted an assessment of the
identity of patients where this is the
introductory stage of the therapeutic
communication process. Some participants
said: " We give our name and ask for the
patient's name " (1.1).
Statement of participants who stated about
saying greetings to patients before
interacting with patients is as follows: "
Patients come we say first greeting we
continue to ask his name who and what age
" (1.2) and " Brother introduced first name
sister continue to ask the name of the patient
and who another one is nah greeting "(1.3)
      Fostering trusting relationships is a theme
formed from sub themes: Openness to the client ,
where the nurse's relationship with the patient
will be established if there is trust. The belief that
comes to know each other, and know the identity
of both the nurse and the patient.
Research conducted by (Hermawan,
2009) there are several stages of therapeutic
communication including introductory stage , at
this stage there are several nurses there who
make introductions and some do not, some of
the nurses only asked me the identity of the
patient, but do not introduce themselves the nurse
itself to the patient , There are several nurse traits
that are still irritable and snappy.
Nurses are required to perform
therapeutic communication in doing nursing
actions for patients or his family knows what
action will be performed on the patient by nurse
should introduce themselves, explain actions to
be performed, made contract time to take action
further nursing. Presence, or the attitude really
exists for the patient, is part of therapeutic
communication. Nurse should not look confused,
patients should felt that he was the main focus
nurses during interaction (Hermawan, 2009 )
        Researchers conducted by Nugroho,
( 2009) states that m hrough nurse and patient
relationships are nurtured b aik, nurses and
patients work together to achieve goals. The
purpose of communication These therapeutics
include: helping the patient in clarifying and results of past actions , which is a part of the
reduce the burden of feelings and thoughts, and therapeutic communication orientation
can take effective action for patients . phase. According to the theory related to this
         Research conducted shows that build a orientation phase p no digging nurse
trusting relationship is a phase introduce nurses grievances felt by clients and individuals
mention the identity where nurses introduced him with symptom others to strengthen the
self at first and ask the identity of the patient, formulation of nursing diagnosis. The
which is a question names, with their purpose of this stage is to validate the
introductory phase will a good relationship accuracy of the data and plans that have been
between nurses and patients. in the current state of the client , so nurses
4. Me the value of interaction in need to listen actively to collect the data
communicating therapeutic with the patient (Nasir, 2009).
Therapeutic communication
     In research conducted (Kusumo, 2017)
undertaken by nurses by assessing the
states that the therapeutic communication
interaction in communicating with the
orientation stage between the nurse and the
patient's therapeutic validate the accuracy of
patient is the most influential stage of patient
patient data se already interacting with the
satisfaction . Research conducted showed
patient, where there is a sub - theme that
that the nurses perform data validation by
forms the theme of evaluating the results of
evaluating contracts or agreements already
past actions
made and planned actions to be taken.
The results of this study prove that
participants with patients always ask back
5. Working together to Solve Patient
about the contract that has been agreed. This
Problems.
is the stage of orientation in the therapeutic
Therapeutic communication is
communication process in the presence of
undertaken by nurses by collaborating with
asking a complaint that has been done
patients to address patient problems by
before. Some participants said: " Asking a
communicating two ways when interacting
complaint to the patient " (1.1) and " what is
with patients, where there are subtitles that
the complaint we need " (1.2)  
form the theme: helping clients dig up
        Validating the accuracy of the data is a important things
theme formed from sub themes: Evaluate the
 The results of this study prove that
nurses perform work with patients in
performing actions that will be done, where
participants reveal: " Take action and solve
patient problems " (1.1) and "d isitu we do
nursing actions patient. Before performing
the act of nursing, surely surely your sister
knows the purpose of doing this action for
what so the patient is not confused "( 1.2)
      Working together to tackle the patient's
nurse problem is a theme that is made up of
sub themes: Help clients dig important
things and do ones where there is a working
phase.
      Stage of work Is the stage to implement
the plan keper a watan that was made , the
importance of nursing services in the
framework of the process of healing the
client,. when nursing actions that will be
done by nurses absence of consent of the
client, then the action can not be done, there
must be similar perceptions, ideas, and
thoughts between clients and nurses in
implementing nursing actions to
performed (Nasir, 2009) .
         This study shows that at the time the
nurse cooperates with the patient to solve the
patient's own problems by performing a pre-
planned nursing action.
6.           Evaluating the Achievement of
Interaction Objectives
Therapeutic communication is
undertaken by the nurse by evaluating the
achievement of the objectives of the
interaction performed with the patient ,
where there are sub themes that make up the
theme: recap the results of the action .
The results of this study prove that
the nurse evaluates the achievement of the
goal of interacting with the patient, re-asking
the feelings felt after the action, such as the
following participant's statement : " Asking
back what feelings have been felt after
action and communication " (1.1) .
        A temporary termination is the end of each
nurse-client meeting, after a temporary
termination, the nurse will be reunited with the
client at a predetermined time. The final
terminations occur if the nurse has completed the
overall nursing process . Tasks per awat at this
stage include evaluated interaction achieve the
objectives that have been implemented, in
evaluating, nurses should not be impressed
testing the ability of the client, but should
impress just repeat or conclude.
be
Research conducted by Kusumo, ( 2017)
states that the therapeutic communication stage is
most influential in patients in Installation
Emergency is the stage terma na si. Termination
stage get a good category in the implementation
therapeutic communication by nurses.
Emergency Installation Emergency is a place to
be found frequently case of emergency that must
be promptly obtained service and nurse are
always first contact with patient 24 hours ,
service professionals should be upgraded because
of an emergency me m emergency services need
fast, accurate and careful with the goal of getting
healing without disabled.
           This study shows that nurses do an
evaluation to the patient by asking a result of the
action taken, in addition to the nurse also
greeting the end of the meeting that was already
done.
7. Facing the patient's difficulty in
communicating
Therapeutic communication is
undertaken by the nurse by evaluating the
achievement of the objectives of the
interaction performed with the patient ,
where there are sub themes that make up the
theme: recap the results of the action
The results of this study prove that
the nurse evaluates the achievement of the
goal of interacting with the patient, re-
inquires feelings after the action, the
presence or participation of the participants :
" Asking back what feelings have been felt
after action and communication " 1.1 )
      The presence of the Nurse faces difficulties
with the patient inside communicate and formed
from sub themes: Client non- conformity to
change, and this is a barrier in therapeutic
communication.
     This obstruction is a result of the
nonconformity client to change, when the
obstacles to change te was felt, this behavior is
usually shown by clients in the working phase,
because the working phase contains the process
of resolving the problem in the patient ( Stuart  
and Sundeen   in   Nurjannah, ( 2005) . Barriers
to therapeutic communication are several types:
resistance , transference , countertransference,
and transgression, where transference is an
unconscious response of feelings or behaviors
toward a nurse who actually starts from dealing
with certain people who are meaningful to him
when he was a child . Cou n tertra n sference   is
a therapeutic communication barrier made by
nurses and not by client .. Boundary offenses,
Nurses need to overcome the relationship with
the client, which needs to be built with the
patient is a therapeutic relationship, in this case
nurse acts as a helper k lien (Suryani, 2005) .
    This research has several obstacles or
deadlocks nurses in conducting therapeutic
communication with the patient and the existence
of the avoidance of the patient , and the difficulty
of the patient to communicate , the difficulty is
due to a physical disorder that becomes an
obstacle the patient is not able to be invited to
communicate.
V. CONCLUSION
 The ineffectiveness of therapeutic
communication between the nurse and the patient
in interacting is useful to improve the patient's
recovery .
REFERENCES
 
Abraham Revelation Nugroho. (2009).
Interpersonal communication between nurses and  
patients.
 
Creswell. (2015). Qualitative research and
research data are chosen among the
five approaches (2nd ed.).
Yogyakarta: Student Literature.
Damayanti. (2008). therapeutic communication
in nursing practice . Bandung: Refika Aditama.
Hermawan. (2009). Perception of Patient on
Implementation of Therapeutic
Communication of Nurse in Nursing
Care in Patient at Emergency Unit of  
RS. Mardi Rahayu Kudus, 1-11.
 
Kusumo, MP (2017). Effect of Therapeutic
Communication of Nurses on Patient
Satisfaction in Outpatient of Jogja
Hospital. Journal of Medicoeticolegal
And Hospital Management, 6 (1): 72-  
81, January 2017 , 6 (1), 72-81. https: //
doi .org / 10.18196 / jmmr.6130.
Mundakir. (2006). Communication Nursing
Application In Service (Graha Science).
yogyakarta.
 
Nasir. (2009). communication in nursing, 142-
143.
Nora Jessica simamora. (2013). Therapeutic
Communication Intensity of Nurse and
Patient, Case Study on Therapeutic
Communication Intensity of Nurse in
Relation to Child Patient's Spirit to Heal
at RSUP H. Adam Malik Medan.
Nurjannah, I. (2005). Therapeutic
communication and counseling in
midwifery practice . Jakarta: Salemba
medika.
Purwaningsih, W & Karlina, I. (2010). Nursing
of the Soul . Yogyakarta: Nusa Medika.
Rahman, A. (2013). Therapeutic Communication
Nurses in motivating the healing of
narcotics addicts and addictive substances.
Roberts, L., & Bucksey, SJ (2007).
Communicating With Patients: What Happens in
Practice? American Physical Therapy
Association Communicating , 87 (5).
Siti, M., & Indrayana, S. (2015). Therapeutic
Communication of Nurses Associated
with Patient Satisfaction with The
Patient's Satisfaction. Journal of Ners
And Midwifery Indonesia , 4 (1),
ISSN2354-7642.
Suryani. (2005). Therapeutic communication,
theory and practice . Jakarta: EGC.
Yularsih, D. (2014). the application of
therapeutic communications in
Indonesia in the process of healing the
patient in the care of the general hospital
in Semarang.